Chronic pelvic pain
| Pelvic and perineal pain | |
|---|---|
 |
|
| Micrograph showing endometriosis (H&E stain), a common cause of chronic pelvic pain in women. | |
| Classification and external resources | |
| ICD-10 | R10.2 |
| ICD-9-CM | 625.9, 789.00 |
| MeSH | D017699 |
Pelvic pain is pain in the area of the pelvis. Acute pain is more common than chronic pain. If the pain lasts for more than six months, it is deemed to be chronic pelvic pain. It can affect both women and men.
Common causes in include: endometriosis in women, bowel adhesions, irritable bowel syndrome, and interstitial cystitis. The cause may also be a number of poorly understood conditions that may represent abnormal psychoneuromuscular function.
Urologic chronic pelvic pain syndrome (UCPPS) is an umbrella term adopted for use in research into pain syndromes associated with the male and female pelvis. It is not intended for use as a clinical diagnosis. The hallmark symptom for inclusion is chronic pain in the pelvis, pelvic floor or external genitalia, although this is often accompanied by lower urinary tract symptoms (LUTS).
Chronic pelvic pain in men is referred to as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and is also known as chronic nonbacterial prostatitis. Men in this category have no known infection, but do have extensive pelvic pain lasting more than 3 months.
Many different conditions can cause pelvic pain including:
Internal hernias are difficult to identify in women, and misdiagnosis with endometriosis or idiopathic chronic pelvic pain is very common. One cause of misdiagnosis that when the woman lies down flat on an examination table, all of the medical signs of the hernia disappear. The hernia can typically only be detected when symptoms are present, so diagnosis requires positioning the woman's body in a way that provokes symptoms.
The diagnostic workup begins with a careful history and examination, followed by a pregnancy test. Some women may also need bloodwork or additional imaging studies, and a handful may also benefit from having surgical evaluation.
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